The resuscitation team was led by The resuscitation team was led by

Print name Signature Position Date Time

completed
V
e
r
s
i
o
n

7
3



.



O
c
t

1
3
C
r
e
a
t
e
d

b
y

M
a
r
t
i
n

W
i
e
s
e
(use sticker if available)
* *
*
Long term conditions Medications
include functional status
Arrest details and preceding events
Team members
circle team leaders name and
underscore scribes name
CPR interventions summary & outcome Key end-tidal CO
2
readings
after 20min ALS
(if appropriate)
on arrival include Rx for any reversible causes (boxes 9-16)
as well as any ECHO findings
omit if already recorded in patients notes omit if already recorded in patients notes
HH:MM HH:MM